However, Delta Dental participating dentists cannot charge you separately for PPE.
The cost of these items has increased with demand, and as a result, some dentists are asking their patients to pay a separate charge for PPE. This includes masks, face shields, gowns and gloves. To help protect themselves and their patients, dentists and staff are wearing more personal protection equipment (PPE) during appointments. If the information in the summary chart differs from the Specific Plan Details Document, the Specific Plan Details Document will govern. Refer to the Faculty and Staff Dental Plan Specific Plan Details Document for further information. NOTE: This Dental Summary Chart should be used as a general guide only. A list of these services can be found in the Faculty and Staff Dental Plan – Specific Plan Details Document. Limited coverage is available under Ohio State’s medical benefits.ġ You are responsible for all costs over the maximums.Ģ For any optional treatment (defined as a service that is more expensive than what is customarily provided or for which Delta Dental does not determine that a valid dental need is shown), you are responsible for the costs over the allowed amount, regardless of whether or not the service is provided in-network.ģ Some services are excluded from the annual maximum. Prosthodontics (includes dentures, fixed bridgework, and implants) and Restorative Services – Major (includes cast restorations and crowns)ĥ5% of allowed amount, no deductible no balance billing 2ĥ0% of allowed amount after deductible no balance billing 2ĥ0% of allowed amount, after deductible subject to balance billing Benefits are pro-rated and paid over the course of the treatment. Benefits are pro-rated and paid over the course of the treatment.Ĭoverage is available for children and adults with no age limit. Preventive Services (includes: cleanings, sealants, fluoride treatments, and space maintainers bitewing, full-mouth or panoramic X-rays), Emergency Palliative Treatments and Oral Examinationsġ00% of allowed amount no deductible no balance billing 2ġ00% of allowed amount no deductible subject to balance billingĮndodontics (root canals), Oral Surgery (includes impacted tooth extraction), Periodontics (gum disease), Restorative Services – Minor (includes fillings, and repair of bridgework crowns, dentures, and onlays) and X-rays, All Others (includes all diagnostic)Ĩ0% of allowed amount, no deductible no balance billing 2ħ5% of allowed amount after deductible no balance billing 2ħ0% of allowed amount after deductible subject to balance billingġ00% of allowed amount, up to $1,200 lifetime maximum 1 no deductibleĥ0% of allowed amount, up to $1,200 lifetime maximum 1 no deductibleġ00% of allowed amount, up to $2,000 lifetime maximum 1 no deductibleĥ0% of allowed amount, up to $2,000 lifetime maximum 1 no deductibleĬoverage is only available for children up to age 19.
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31, 2022 2022 Dental Summary Chart PDF Version Covered Servicesĭelta Dental PPO Network (includes OSU Student Dental Clinic)
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